One month!! Thankful!!

It is 8/8/14. We opened our doors 7/7/14, so that means we have one month under our belt!!  Woohoo!  We did it/are doing it!  Things are coming along very well.   We have helped almost three hundred ladies with their urological issues so far and have registered almost 400 into our system for appointments.  We’ve started doing surgery through the new practice: some bladder repairs and a few stones. And our pelvic floor program is in full swing.  We have been busy!

I truly feel blessed.   This is the realization of a dream that I have had for many years: to have a urology clinic for women and to have my own practice.  It is so fulfilling.  Everything is the way that I have envisioned it:  a beautiful, calm, clean office where patients can feel assured that they will be treated gently and professionally.  My staff is amazing.  They have put their heart and soul into this start-up and they truly see this as a mission to help women and not just another job.   I am so proud of them.  And, we have a lot of fun together!

There are of course, moments of doubt.  These are brief moments, but a frustration will occur and I will think, “what have I done?!?”  Gulp.  But in those times, I stop and think, “Christi, remember who is in ultimately in control here.   Who has orchestrated everything to make this happen?  Who has paved the way, given you the desire to be a doctor since you were three years old, opened up and closed the right doors along the way?  God has got you, and He has your practice, too.  The whole thing is squarely in His strong hands.  Rest.  Don’t worry.  This is His practice.”  He gives me a strong peace and courage to continue forward.  It’s all going to be good.

So, I am incredibly blessed and thankful and peaceful about this adventure.  Life is too short not to make big moves and walk by faith!  If I weren’t a Christian, I would be a wreck, I think.   But knowing that God has already paved the way and having His peace, I can relax.  I can just lean on Him and go step by step.   He has placed me here at this time, and my job is to trust Him and share the love of Christ through urology!

 

 

Bladder lifts 101

As I await my surgery this morning, which is a biological graft bladder lift, I thought I would take the opportunity to discuss bladder lifts.  What they are and the various options.

As we age, and especially if we have had vaginal deliveries, the bladder can start to fall.  The ligaments that surround the bladder get stretched out and the vaginal wall isn’t strong enough alone to support the bladder anymore.  This is called a cystocele.  It is sort of like a hernia in the vagina.

The symptoms may be a bulging in the vagina, a feeling that you are sitting on a ball, difficulty emptying your bladder, recurrent urinary tract infections, and some women even have to push their bladder up to be able to empty it.  We fix it when it the bulging becomes too great a bother, the bladder cannot empty well at all, or there are a lot of bladder infections.

The first thing we’ll try is a pessary.   This is like a donut that we can insert in the office that will literally push the bladder up where it belongs.  When fitted properly, it will stay in place but you won’t be able to feel it.  This can be a long-term solution or a temporary measure until surgery.   The maintenance on it is to come in to the office every 8 weeks to have it cleaned and to check the vaginal walls.

Surgically, there are four main options:

  1. Traditional tissue plication.  This is the old-fashioned lift where we simply stitch the walls of the vagina tighter to make a shelf for the bladder.  It works for a lot of people, but the failure rate is reported in some studies as high as 40%, so that’s why we started looking for other alternatives.   You may know someone who has had numerous bladder lifts.  It is still an option, however, and is done quite frequently.
  2. Biological graft placement.  This procedure uses tissue that has been processed to make a supportive sheet about 3X4 inches in size.  The two main ones that I use are Xenform, which is made from calf skin and looks like a sheet of pure collagen, and Repliform which is made from human cadaveric skin.  The cells are taken out of the graft to make it just a sheet of collagen and to prevent spread of any disease at all.  These grafts supplement your natural tissues which have been proven to be weak.  I put these in with a vaginal procedure.
  3. Mesh graft placement.   Mesh??   “The mesh from those lawyer commercials?”  Yes, the mesh from the commercials. It is still a good option.   There have been no recalls of mesh at all.   It does have to be done properly, and I reserve it for the patients who have failed other techniques.   Having done hundreds of mesh implants, I can tell you that it works very well and patients do well.  It’s not perfect, but, then again, no surgery is.
  4. Robotic bladder lift.   This procedure is approached from above with scopes through the abdomen, in contrast to the other three methods which are all done through the vaginal wall.  This method is usually done in conjunction with the gynecologist doing a hysterectomy.  The robot helps me sew the mesh onto the vagina more efficiently and precisely.

All of these surgeries typically involve one night in the hospital and low levels of pain.  You do have to avoid heavy lifting or heavy exercise for about six weeks afterwards while you heal.

And there you have it.  I use all of these options regularly.  It just depends on the patient: how bad the cystocele is, her age, prior surgeries, the health of the vaginal wall.  That’s where I spend time getting to know you, evaluating you and what you need.

Please call our office if you would like a consultation about your bladder:  281-717-4003.   This is what we do!

 

 

Exhausted, but worth it: Week One of New Practice

Well, we’ve almost completed our first week of the new practice!  Oh, boy!  I am pretty exhausted.   And I feel like I have ADD.  One minute I’m discussing surgery with a patient, the next fine-tuning the process of ordering tests, next hanging a scope sterilization caddy on the wall, next minute learning about Google Adwords.

It’s like when you are trying to clean your house and you move the blanket to your bedroom, only to see a cup that needs to go to the kitchen, and in the kitchen is your child’s backpack that needs to go to their room.  Like that.  But it’s every day, all day. 7a-7p. I am not really stopping for meals, just working and grazing.

It’s all-consuming.  I can’t stop thinking about the new practice and trying to get every little thing just the way that I think it should be.  I know that the day is coming when I will again mostly be spending my time practicing medicine, my first love, and spending less time on the business part, which I like, but it wears me out.  It doesn’t feed my soul the same way.

I do love it, though.  Building something.  Creating a business and a place of healing.  Helping people with their bladder problems. Yes, I’m a doctor who hasn’t lost the drive and satisfaction to help people.  That is what keeps me from burn-out.  Keeps me going no matter what frustration comes along.  It is just the best feeling to have a patient smiling and hugging you, because she doesn’t need to wear pads anymore.

I love that I’m also able to employ some great women and (hopefully) help them realize the life that they dream of.  And I couldn’t do any of this without their dedication.  I truly get so much more from them than I give to them.  We have a great team, and everyone has the vision to fulfill the mission of our practice.  And we have a lot of silly fun as seen on the Facebook page.

Some of the challenges and frustrations that we’ve encountered:  Well, day one, the Comcast internet wasn’t working.  In fact it has gone down a couple more times since then.  We have a new modem now, so hopefully that will help.  And hey, Comcast sent me a $20 credit today!  Internet is essential because our medical records are cloud-based.  Thank goodness that Methodist has a free guest wifi.  Otherwise, I’d have to pay for a backup internet service.

Challenge two:  As much as we tried to learn the new Kareo electronic health records (EHR) ahead of time, there is just no way to know all the ins and outs until you go live.  Day 4 now, it is getting much easier.  We have figured out some good shortcuts.

Challenge three:  Today we started using our Phreesia pads.  I was hoping they would be ready Monday, but they weren’t.  Another lesson in letting go of the desire for perfection!  These are like ipads that patients use to check in and pay their co-pay.  Very cool.  At first, they didn’t work too well, but by the end of the day we were starting to see the light.  Patients seem to like them.  Decreasing paper waste!

We started out the week with one patient per hour so that we would have plenty of time to figure everything out and that was key.  I’m still going to limit the number of patients for a while until we really start to feel like we are getting efficient.  The patients have been so wonderful and patient with us.  Sweet ladies.

I say we’re off to a good start!  I think we are all tired and longing for the smooth-running machine that we all know we are capable of.  It will take some time, but each day gets a little easier.  It’s like the beginning of a run when you are sucking wind and just want to slow down or stop. BUT, if you can get past mile 3, the breathing gets easier, you reach your stride, and then you are cruising for the long run.

 

What IS Female Urology????

When I first signed up for a urology rotation in medical school, I thought I was going to spending the next 6 weeks seeing old men with prostate cancer.  I really was not interested in urology at that time, but I needed something to fill my fourth year schedule. What I really wanted to do was anesthesiology: putting in IVs and breathing tubes, lots of fun procedures.

But, the anesthesia rotation was already spoken for. So, now what? Well, I was planning to be a gynecologist, so I thought, well, at least if I do urology, then I’ll get more exposure to the pelvic anatomy. Get a refresher course on all the blood vessels and structures. That will be helpful, right? Even if it is just old men and their prostates.
Well, I couldn’t have been more wrong. Even then I didn’t realize just how wrong I was. Now as I sit here practicing not just urology, but 100% female urology, it is ironic that I thought that it was only prostates!
Of course, urology does encompass prostates in men. It includes everything in the urinary tract from the kidneys through the bladder and out the urethra. Urologists have medical treatments and all kinds of surgeries to treat patients. We treat patients from birth through death, men and women, boys and girls for everything from bedwetting to terrible cancers. It is a great variety surrounding that one part of the body. That’s the reason I fell in love with urology and switched from my pursuit of gynecology.
Female Urology, of course, focuses on the female urological tract. We don’t have prostates, so we don’t need to worry about that (thank God!), but we do have other issues. The most common issue that we have is overactive bladder and incontinence. God made us with short urethras (the pipe that the urine comes through) and a big opening in our pelvis muscles to allow us to have babies. If that opening gets stretched out, such as after having babies, then we start to have problems with organs dropping and having a difficult time controlling our urine. Sometimes it happens even if one has had only C-sections, or has no children.
Female urology is here to help with that! We have everything from physical therapy to medications to surgery to pacemakers, Botox and more. It is a very exciting time because we have some very effective treatments for this now, whereas ten years ago, the options were very limited. You don’t have to live with those pads your whole life!
That is not all that Female Urology entails. It also includes urinary tract infections, painful bladder conditions, kidney stones, evaluation of blood in the urine, slow urinary stream, bladder and kidney tumors, and more.
There is even now a subspecialty, in which I am certified, called Female Pelvic Medicine and Reconstructive Surgery, which focuses on certain conditions of the pelvic floor, especially prolapse (dropped organs) and incontinence. There are even more advanced surgeries that can be used to treat these conditions, including robotic surgery, which I have been doing for several years with beautiful results (beautiful from a pelvic surgeon’s perspective!).
Over the last twelve years, I have narrowed my urology practice down to females only. I couldn’t be more pleased with my choice. I get to treat some lovely women and see them get their life back: from a life of pads and worrying about where every bathroom is to urine control. And for others, it is helping them with infections, pain, stones, or reassuring them that the blood found in the urine isn’t serious for them. Female Urology is my complete career focus and my mission.

Looking Back at 2015

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As 2015 draws to a close, I can’t help but look back on this year and think about how far Houston Female Urology has come since we first opened in July 2014. This year we celebrated our one-year anniversary. That’s one year in the books as the only urology practice in Texas that exclusively serves women. This is something that makes my team so proud. It’s an honor to help our patients get their lives back and say goodbye to urological issues every day.

This year we also added the MonaLisa Touch laser – a leading edge treatment that resolves gynecologic health issues often caused by menopause. I offer this as an in-office procedure that is virtually painless and requires no anesthesia. I am excited to be one of the first physicians in Houston to offering this treatment to help postmenopausal women and breast cancer survivors. (We are also thrilled that the Houston Chronicle covered our story!)

I love interacting with my patients. One way I did this in 2015 was through free seminars. My team organized two amazing events where our patients (and their friends!) were able to gather and learn more about urological issues and treatment options. We had drinks, snacks, door prizes – the events were so successful that I’m already planning more free events for 2016!

Giving back is something that is really important to my practice. This year we gave new athletic clothing wear and monetary donations to Houston Area Women’s Center. We prayed that these donations would bless the women who receive them as they break free from domestic abuse and start a new life.

So as the year winds down and Christmas approaches, I pray for real joy and peace for the whole world. So much heartache has happened in 2015, and it reminds me of the poignant lyrics of the Christmas song, Oh Holy Night – “A thrill of hope, the weary world rejoices.” Take time to rest and not get caught up in the hustle and bustle of the season. This is a time for joy – God reached down to touch mankind.

Enjoy your fresh start to a new year, and come see me in 2016! I can’t wait to continue providing the same great care to my patients.

Dr. P

Welcome

Hello, I am Dr. Christina Pramudji. I am a urologist who is a female who only does female urology, and I LOVE it!  This is where I intend to blog about female urology, about the conditions that many women have, the treatments that can help them, and about my journey into solo practice.  Thank you for reading my blog!

Meet the MonaLisa Touch

 

MonaLisaTouchI am thrilled to announce that I will be introducing a new vaginal laser treatment as an outpatient procedure this fall at Houston Female Urology. As the first urologist in Houston who’s taking advantage of this groundbreaking technology, I can’t wait for my patients to reap the benefits! Meet the MonaLisa Touch.

The MonaLisa touch is a treatment aimed at combating vaginal atrophy. Vaginal atrophy may be caused by hormonal changes during menopause, and it may also occur in women who experience a decreased estrogen production due to cancer or breastfeeding. Thinning, drying and inflammation of the vaginal walls are typical characteristics, and it may cause intercourse to be painful and contribute to problems with urination.

My patients who experience these symptoms will now be able to restore youthful, trophic conditions in the vulvo-vaginal area with the MonaLisa Touch. The MonaLisa Touch is a minimally invasive laser method that is completely reliable. Its CO2 laser source emits an impulse, and the method does not trigger negative effects like some hormone-based therapies.

Often during the period of menopause, the vagina is subject to a loss of swelling and hydration of tissues, which may cause discomfort for many women. As I mentioned earlier, some of the symptoms include itchiness, dryness, burning, loosening of the vagina and pain during sexual intercourse. Not only do these symptoms cause discomfort, but they can also interfere with your quality of life.

I am excited about the MonaLisa Touch because it naturally and painlessly overcomes vaginal atrophy by triggering physiological processes that eliminate signs of aging. Most importantly, the treatment brings an improvement in physical conditions that enable women to feel like their vulvo-vaginal areas are aging in reverse.

Stay tuned as we share more information throughout the coming days and weeks about the MonaLisa Touch. I think you’re going to love it!

Dr. P

There’s blood in my urine?

It’s a scary thing to find. When a patient sees blood their urine (hematuria), there are often many unknowns that race through their mind. I always stress that patients need to seek medical attention the first time they see it. Don’t even ignore a small amount. Call our office immediately, and make an appointment.

During the appointment, we will look at the entire urinary tract, first with imaging of the kidneys by a CT scan or a renal ultrasound and follow that with a KUB. Then, we will do a scope of the bladder, called a cystoscopy. It is a quick procedure with numbing medicine. While it sounds intimidating, patients are often surprised at how easy it is. The discomfort is similar to a Pap smear.

The most common cause of hematuria is a UTI. The infection can irritate the bladder wall to the point that it often bleeds. Other things we look for are a kidney stone, kidney tumor or bladder cancer.

While it is uncommon, occasionally we find a bladder or kidney tumor as the source of bleeding. Obviously, the sooner that a tumor is found and treated, the better. Tumors in the kidney and bladder will need to be removed surgically. Fortunately, we have great, minimally invasive options to remove these tumors without a large incision.

Often we will see patients for microscopic blood in the urine detected by their primary care doctor. While not as serious, it still requires a complete panel of testing.

Your treatment options will depend on what the testing shows. A UTI will be treated with antibiotics, water and other measures of prevention. If we find a kidney stone, then the treatment could be a number of various options to eliminate the stone, including laser and shock wave therapy, which are both minimally invasive options.

Whatever the cause, it is of the utmost importance to call our office at the first sign of blood in your urine. Our caring staff is here to help you.

– Dr. P

Restoring Your Health, After the Storm

To all of our patients who were impacted by flooding, we are deeply sorry and send our prayers to each and every one of you. We hope that you and your families are all safe and dry, and on your way to recovering from the storm.

In the aftermath of Harvey, I know we are all trying to figure out how to pick up the pieces and start to return our lives to normal. Looking around at all of the devastation, it’s hard to see that things will ever be the same again, but we can start with baby steps and hopeful hearts.

As women, we have been consumed with caring for others. Protecting our families and homes has been our sole focus lately, and there hasn’t been much energy left to look inward at our own well-being. Now that the rebuilding process has begun, it is so important that we rebuild our health, as well.

Hurricane Harvey compromised many of our patients’ urological and pelvic health, and we want to help guide you back to a healthier state. Two female urological problems have come to the forefront during this disaster:

  1. Urinary Tract Infections (UTI)
    Have you been helping in flooded areas? The standing water is not clean, and it contains all sorts of things that can cause a UTI. If you are experiencing pelvic pain, an increased urge to urinate, pain with urination, or blood in the urine, please call our office. Another cause of UTIs is being out of your regular routine and not drinking enough water. Think about it: what have you been drinking over the last couple of weeks? I bet it has been more soda and wine, and less water. Our bodies need water to re-balance what has gotten off track. Make an effort to increase your water intake, and your urinary tract will thank you.
  2. Interstitial Cystitis and Pelvic Floor muscle spasm
    Hunkering down always seems to include a variety of unhealthy meals and snacks. It’s hard to focus on healthy eating in the middle of a hurricane, and unfortunately your pelvic health suffers. If you were already dealing with Interstitial Cystitis (painful bladder syndrome) or Pelvic Floor muscle spasms, chances are you are feeling worse these days. Now it’s time to focus on healthy foods again.

While you are working to restore your sense of normalcy, please remember to take time for yourself. Getting back to a healthy routine will help both you and your families feel better.

Cheers to a healthy you!
-Dr. P

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Preventing Kidney Stones in women

Did you know that women are just as likely to get kidney stones as men???  I don’t know why, but there is a perception that women don’t get stones as often as men.  But we all have two kidneys, which is where stones originate.

Stones are literally just that: rocks.  If you have never actually seen a kidney stone, they look exactly like rocks.  They are made of minerals that crystallize in the kidneys and then conglomerate together to form a stone.  As long as the stones are sitting up in your kidney, they usually don’t cause any pain.  But if they decide to pass and start heading down the urinary tract, look out.   It is the worst pain that humans endure.  Women who have had natural childbirth and have a passed a kidney stone will tell you that they would much rather have a baby any day!

You do not want a kidney stone!  As much as a I love stone surgery (laser surgery is like playing a video game, all that time playing Ms. Pac-man is paying off now, Mom), I know you don’t want to have to go through that.  Here’s how to prevent them:

  1. Number one is to drink more water and lemonade.  The solution to pollution is dilution.  If there is so much water flushing through the kidneys that the minerals can’t crystallize, then you won’t get a stone.  Lemonade naturally has citric acid which is a stone inhibitor.   Homemade lemonade is best, but I’ll be happy if you drink Crystal Light or Chik-fila lemonade.  Definitely better than soda or iced tea.  Those drinks actually cause stones.
  2. Drink enough water so that your urine comes out clear.
  3. Avoid soda and iced tea.  Yes, repeating myself.
  4. Become a vegan.  Well, as much as possible.  Not only is it the healthiest lifestyle for yourself and the planet, but some of the biggest culprits of kidney stones are meat and dairy.  By meat, that includes chicken and fish, as well as beef and pork.   You do not need to eat animals to live.  I have seen so many people develop kidney stones after doing the Atkins Diet.  If you feel you can’t give up your meat, at least limit it to two servings the size of your palm per day.  Animal protein metabolizes into something called acid ash which causes stones.  It also leaches the calcium from your bones and causes osteoporosis.  Read The China Study (the most comprehensive study on nutrition ever conducted) and become vegan.  It is not as hard as you think.  I did it five years ago.

If you have a family history of stones, you are more prone to get one yourself, so get on this!  If you have ever had a stone, you have a 10% chance each year thereafter that you will get another one.

Be healthy and hydrated!!

Dr. P